Without a laparoscopy

• the diagnosis is only a suspicion of superficial endometriosis, except when a cystic ovarian endometriosis was diagnosed by ultrasound
• If pain started acutely endometriosis is unlikely.  A cystic corpus luteum needs to be excluded.
• If a BIG deep endometriosis nodule is diagnosed by clinical exam or ultrasound (MRI), the diagnosis is probably correct ; for smaller lesions the risk of false positives and of false negatives is high
• I you do not know  the type of endometriosis your gynecologist is probably is not a real  specialist

If a laparoscopy is planned, you need to check

• A cystic ovarian endometriosis of more than 6 cm needs surgery in 2 steps otherwise the ovary risks to be destroyed.
• If a large deep endometriosis is suspected, hydronefrosis  (e.g. with  ultrasound) and bowel stenosis (with a contrast enema) need to be excluded before surgery
• An ureter stent is indicated only in cases of hydronefrosis
• Check the level of expertise of the surgeon and the percentage of bowel resections performed. A bowel resection is rarely needed  (<10%) and should be decided during surgery. Too often avoidable bowel resections are performed.

Surgery was not performed during the laparoscopy

• The diagnosis is probably correct
• Check the photo’s or video to ascertain that all has been checked such as  appendix, the sigmoid and diaphragm
• This is correct; if lesions were unexpectedly severe it is better not to do surgery without the required expertise.

If surgery was performed,  you should know at least.

• the type of intervention and the type of endometriosis
• complete or incomplete excision  ?
• complications  ?
• duration of surgery ?
• video or at least photo-documentation ?

Medical treatment was started without a  laparoscopy, thus without a diagnosis

• this can be done occasionally on the waiting list, not as a preparation for surgery
• this can be given for a short period to evaluate the effect on pain
• for a longer period without a diagnosis is a mistake